Suaugusiųjų sinkopė

Suaugusiųjų sinkopė

Sinkopė – tai trumpalaikis sąmonės netekimas dėl staigios trumpalaikės smegenų hipoperfuzijos (1). Tyrimų duomenimis, sinkopė pasireiškia net 41 proc., o sinkopės pasikartojimas – 13,5 proc. žmonių (2). Sinkopė dažniausiai ištinka netikėtai, trunka trumpai, o atsigaunama spontaniškai. Su sąmonės netekimu dažnai pasireiškia kolapsas, dėl to galimi griuvimai ir susižalojimai. Sinkopė – tai tik viena iš daugelio trumpalaikio sąmonės netekimo priežasčių. Kitos priežastys gali būti: traukuliai, smegenų trauma, intoksikacija, miego sutrikimai, metaboliniai sutrikimai, kai kurios psichiatrinės ligos, galintys lemti pseudosinkopę. Šių būklių diferencinė diagnostika gali būti nelengva, tačiau būtina siekiat išsiaiškinti etiologiją, parinkti diagnostikos metodus, gydymą, įvertinti prognozę, užkirsti kelią pakartotiniam sąmonės netekimui ir pagerinti gyvenimo kokybę.

 

Sinkopių rūšys

 

Yra 3 pagrindinės sinkopių rūšys: refleksinės (neurogeninės), ortostatinės hipotenzijos ir sukeltos kardiovaskulinių ligų (1 lentelė). Dažniausia sinkopės priežastis – neurologinė refleksinė sinkopė (21 proc.), antroje vietoje – kardiovaskulinės kilmės sinkopė (9 proc.) bei ortostatinės hipotenzijos sukelta sinkopė (9 proc.). Nežinomos priežasties sinkopės sudaro 37 proc. (4). Refleksinių sinkopių grupę sudaro vazovagalinės, situacinės ir karotidinio sinuso sindromo sukeltos sinkopės.

Dažniausios priežastys, lemiančios sinkopės pasikartojimą vyresniems pacientams, yra aortos stenozė, inkstų funkcijos nepakankamumas, atrioventrikulinė ar kairės Hiso pluošto kojytės blokada, vyriškoji lytis, lėtinė obstrukcinė plaučių liga, širdies nepakankamumas, prieširdžių virpėjimas, medikamentų, galinčių sukelti ortostatinę hipotenziją, vartojimas (3).

 

1 lentelė. Sinkopių rūšys ir duomenys, leidžiantys jas įtari

Sinkopių rūšys

Duomenys, leidžiantys įtarti tam tikros rūšies sinkopes

Nervinės refleksinės kilmės sinkopė

Širdies ligų nebuvimas

Sinkopė po staigaus nemalonaus vaizdo, garso, kvapo ar skausmo

Sinkopė ilgai stovėjus ar esant karštose, sausakimšose vietose

Vėmimas, pykinimas, lydimas sinkopės

Sinkopė, susijusi su galvos pasukimu ar karotidinio sinuso spaudimu (ankštos apykaklės, skutimasis)

Sinkopė po buvusio fizinio krūvio

Ortostatinės hipotenzijos sukelta sinkopė

Sinkopė stojantis

Sinkopė esant autonominei neuropatijai ar parkinsonizmui

Sinkopė ilgai stovėjus, ypač karštose, sausakimšose erdvėse

Sinkopė atsistojus po buvusio fizinio krūvio

Kardiovaskulinės kilmės sinkopė

Anamnezėje šeimoje buvę staigių, neaiškios kilmės mirčių ar kanalopatijų

Sinkopė esant dideliam fiziniam aktyvumui

Pakitimai elektrokardiogramoje

Sinkopė ramybėje, gulint

Anksčiau nustatyti širdies pakimai

 

Pacientų ištyrimas

 

Nustačius, kad pacientui yra buvęs sinkopės epizodas, reikia patikslinti sinkopės priežastį. Neretai pacientai serga ne viena lėtine liga, kuri ir gali būti trumpalaikio sąmonės netekimo priežastis, todėl reikalingas detalus ištyrimas. Beveik visiems pacientams pirminis sinkopės įvertinimas turėtų susidėti iš anamnezės, fizinio ištyrimo (vyresniems asmenims reikėtų apsvarstyti sinusinio mazgo masažo atlikimą) bei elektrokardiogramos atlikimo. Po pirminio paciento įvertinimo reikėtų spręsti dėl širdies echoskopijos, siekiant įvertinti širdies ertmes, vožtuvų būklę, jei pacientui žinoma širdies patologija ar ji įtariama atlikus apžiūrą ar elektrokardiogramą. Išsamesnis ištyrimas priklauso nuo numanomos sinkopės priežasties (5). Sinkopės priežastis neturėtų būti nustatoma neatmetus galimų kitų priežasčių.

Anamnezės surinkimas, detalus fizinis ištyrimas turėtų būti atliekamas visiems sinkopę patyrusiems pacientams (I klasės B lygio rekomendacija) (6). Svarbu išsiaiškinti sinkopių trukmę, jei pasikartoja – pasikartojimo dažnį, kiek laiko pasikartoja (metus, mėnesį). Jei sinkopės vargina ne vienus metus, neretai sinkopę sukėlusi priežastis nekelia gyvybei grėsmės. Kitaip gali būti, jei sinkopės pasireiškė neseniai, dažnai kartojasi, tai gali būti sunkios būklės padarinys, tokios kaip paroksizminė skilvelinė tachikardija, AV blokada ar kita, ir reikalauja detalaus, neretai ir stacionarinio ištyrimo (2 lentelė).

Plačiau skaitykite žurnale „Internistas“ Nr.7, 2017 m.


144 mintys apie “Suaugusiųjų sinkopė

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